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Marincowitz C, Hasan M, Omer Y, Hodkinson P, McAlpine D, Goodacre S, Bath PA, Fuller G, Sbaffi L, Wallis L. Prognostic accuracy of eight triage scores in suspected COVID-19 in an Emergency Department low-income setting: An observational cohort study. Afr J Emerg Med 2024; 14:51-57. [PMID: 38317781 PMCID: PMC10839866 DOI: 10.1016/j.afjem.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 12/08/2023] [Accepted: 12/24/2023] [Indexed: 02/07/2024] Open
Abstract
Introduction Previous studies deriving and validating triage scores for patients with suspected COVID-19 in Emergency Department settings have been conducted in high- or middle-income settings. We assessed eight triage scores' accuracy for death or organ support in patients with suspected COVID-19 in Sudan. Methods We conducted an observational cohort study using Covid-19 registry data from eight emergency unit isolation centres in Khartoum State, Sudan. We assessed performance of eight triage scores including: PRIEST, LMIC-PRIEST, NEWS2, TEWS, the WHO algorithm, CRB-65, Quick COVID-19 Severity Index and PMEWS in suspected COVID-19. A composite primary outcome included death, ventilation or ICU admission. Results In total 874 (33.84 %, 95 % CI:32.04 % to 35.69 %) of 2,583 patients died, required intubation/non-invasive ventilation or HDU/ICU admission . All risk-stratification scores assessed had worse estimated discrimination in this setting, compared to studies conducted in higher-income settings: C-statistic range for primary outcome: 0.56-0.64. At previously recommended thresholds NEWS2, PRIEST and LMIC-PRIEST had high estimated sensitivities (≥0.95) for the primary outcome. However, the high baseline risk meant that low-risk patients identified at these thresholds still had a between 8 % and 17 % risk of death, ventilation or ICU admission. Conclusion None of the triage scores assessed demonstrated sufficient accuracy to be used clinically. This is likely due to differences in the health care system and population (23 % of patients died) compared to higher-income settings in which the scores were developed. Risk-stratification scores developed in this setting are needed to provide the necessary accuracy to aid triage of patients with suspected COVID-19.
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Affiliation(s)
- Carl Marincowitz
- Centre for Urgent and Emergency Care Research (CURE), Population Health, School of Medicine and Population Health, University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK
| | - Madina Hasan
- Centre for Urgent and Emergency Care Research (CURE), Population Health, School of Medicine and Population Health, University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK
| | - Yasein Omer
- Division of Emergency Medicine, Groote Schuur Hospital, University of Cape Town, F51 Old Main Building, Observatory, Cape Town, South Africa
| | - Peter Hodkinson
- Division of Emergency Medicine, Groote Schuur Hospital, University of Cape Town, F51 Old Main Building, Observatory, Cape Town, South Africa
| | - David McAlpine
- Division of Emergency Medicine, Groote Schuur Hospital, University of Cape Town, F51 Old Main Building, Observatory, Cape Town, South Africa
| | - Steve Goodacre
- Centre for Urgent and Emergency Care Research (CURE), Population Health, School of Medicine and Population Health, University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK
| | - Peter A. Bath
- Centre for Urgent and Emergency Care Research (CURE), Population Health, School of Medicine and Population Health, University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK
- Information School, University of Sheffield, Regent Court, 211 Portobello St, Sheffield S1 4DP, UK
| | - Gordon Fuller
- Centre for Urgent and Emergency Care Research (CURE), Population Health, School of Medicine and Population Health, University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK
| | - Laura Sbaffi
- Information School, University of Sheffield, Regent Court, 211 Portobello St, Sheffield S1 4DP, UK
| | - Lee Wallis
- Division of Emergency Medicine, Groote Schuur Hospital, University of Cape Town, F51 Old Main Building, Observatory, Cape Town, South Africa
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Abdoalgadir MA, Mohamed Ahmed KAH, Alhusseini RT, A. Hasabo E, Hemmeda L, Elnaiem W, Mohamed RIB, Abdalla MOA, Abdalmaqsud muhmmed KA, Taha OMN, Husni Yousef YSA, Hassan Alrufai RR, Ahmed Mohammed Alamin AE, Musa MMM, taha abdallah SAM, Fadelallah Eljack MM, Kharif BMA, Mohamed Idris AIA, Idris SMA, Mohamed MAA, Gurashi MSO, omer Mohammed MA, Ahmed ABM, Nasr IMH, saeed ASM, Omer MEA, ElSayed A, Almahie Shaban MA. Knowledge, attitude and practice of medical students towards COVID19 in Sudan: A cross sectional study among 19 universities. Ann Med Surg (Lond) 2022; 84:104874. [PMCID: PMC9659355 DOI: 10.1016/j.amsu.2022.104874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/26/2022] [Accepted: 10/30/2022] [Indexed: 11/15/2022] Open
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Predicting Intensive Care Unit Admission for COVID-19 Patients from Laboratory Results. DISEASE MARKERS 2022; 2022:4623901. [PMID: 35634446 PMCID: PMC9133894 DOI: 10.1155/2022/4623901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/19/2022] [Accepted: 05/11/2022] [Indexed: 11/17/2022]
Abstract
Trends in routine laboratory tests, such as high white blood cell and low platelet counts, correlate with COVID-19-related intensive care unit (ICU) admissions. Other related biomarkers include elevated troponin, alanine aminotransferase, and aspartate transaminase levels (liver function tests). To this end, the aim of this study was to investigate the effect of changes in laboratory test parameters on ward-based and ICU COVID-19 patients. A total of 280 COVID-19 patients were included in the study and were divided based on admission status into ICU (37) or ward (243) patients. ICU admission correlated significantly with higher levels of several tested parameters, including lactate dehydrogenase, creatinine, D-dimer, creatine kinase, white blood cell count, and neutrophil count. In conclusion, routine laboratory tests offer an indication of which COVID-19 patients are most likely to be admitted to the ICU. These associations can assist healthcare providers in addressing the needs of patients who are at risk of COVID-19 complications.
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